Investigating the Relationship between Magnesium levels and Diabetes Mellitus in Pregnant Women

Gestational diabetes mellitus (GDM) is defined as one of the three main types of diabetes mellitus (DM). It is established that GDM is associated with exceeding nutrient losses owing to glycosuria. Magnesium (Mg), as one of the essential micronutrients for fetus development, acts as the main cofactor in most enzymatic processes. The aim of this study was to measure serum and cellular levels of Mg, albumin, creatinine, and total protein to further clarify the relationship between these components and DM in pregnant women. Blood samples were obtained from 387 pregnant women. The participants were classified into four groups based on their type of diabetes, namely GDM (n=96), DM (n=44), at high-risk of DM (n=122), and healthy controls (n=125). All participants' fasting blood sugar (FBS), creatinine, albumin, Mg, and total protein in the serum levels and red blood cell Mg (RBC-Mg) were measured during 24-28 weeks of gestation. Groups were compared for possible association between DM and abortion, gravidity, and parity. The serum levels of creatinine, FBS, albumin, Mg, and RBC-Mg were statistically different among four groups (P =0.001). Significant lower levels of RBC- Mg was observed in all studied groups in comparison with controls. Given a positive correlation between DM and abortion, it seems that decreased levels of RBC-Mg and serum albumin can increase the risk of abortion in pregnant women. Our data demonstrated significant alterations in albumin, Mg, and creatinine concentrations in women with DM or those at high risk of DM during their gestational age. It seems that the measurement of these biochemical parameters might be helpful for preventing the complications, and improving pregnancy outcomes complicated with DM.

agnesium (Mg) is the second most abundant cation after potassium inside living cells.
Out of 21-28 g Mg that is present in an adult's body, 99% is present in intracellular space and only 1% is present in extracellular fluid (1). In healthy individuals, plasma Mg concentrations are relatively stable within the range of 0.70-1.00 mM (2). Mg, as one of the essential micronutrients for fetus development, can act as the main cofactor in most enzymatic processes (3). On the other hand, Mg plays a key role in calcium homeostasis, affecting the activity of ATPase (4). Since calcium has an important role in insulin release and glucose metabolism, it can be concluded that this cation may play a prominent role in the processes of glucose and oxygen supply for cellular glucose oxidation (5). Determination of a threshold for Mg insufficiency status is usually difficult since it depends on the health status and other characteristics of the target population (6). Mg deficiency has been associated with increased risk of cardiovascular disease (7), type 2 diabetes (8), metabolic disorders (9), and pregnancy (10).
Gestational diabetes mellitus (GDM) is defined as one of the three main types of diabetes mellitus (DM) (i.e. type 1, type 2, and GDM), which is detected in almost 3-5% of pregnancies (11). GDM refers to carbohydrate intolerance causing hyperglycemia with the onset or first recognition during pregnancy (12). In addition, it is established that GDM is associated with exceeding nutrient losses owing to glycosuria (13). Bardicef

Biochemical analyzes
All participants underwent fasting blood sugar (FBS), creatinine, albumin, Mg, total protein levels in the serum, and red blood cell Mg (RBC-Mg) measurements during 24-28 weeks of gestation.
Patients' albumin, total protein, and creatinine

Statistical analysis
The data are presented as mean ± SD, median and percentage. Either the independent samples t test or one-way ANOVA test was used to discover any differences among four groups. All analyses were performed using PASW statistics 18 (SPSS).
Based on One Sample Kolmogorov-Smirnov test, our data did not have a normal distribution. Therefore, the comparisons between two groups were performed by non-parametric test. Pearson's correlation was run to calculate correlations.
Logistic regression was also applied to examine the relationship between the measured factors and the rate of fetus/embryo abortion. Chi-square and Fisher exact test were used to determine the relationship between DM and gravidity or abortion across four groups. Moreover, a receiver-operating characteristic (ROC) curve was performed for evaluating diagnostic performance and accuracy of a test to discriminate between cases and controls by ROC curve in MedCalc statistical software. A value <0.05 was considered statistically significant.
The Tukey test was performed to test all pairwise comparisons among means.

Results
In this study, participants of four groups were similar in terms of age (P =0.8), height (P =0.9), and BMI in different time intervals during pregnancy (P>0.05) ( Table 1). Table 1  Chi-square test revealed no correlation between gravity and DM (P=0.06). However, there was a positive correlation between DM and increased parity as well as fetus abortion (P =0.001) ( Table 3). According to chi coefficient, the severity of this correlation was about 18 %. Moreover, high specificity and sensitivity with significant values were observed in the ROC curves ( Figure 1 and Table 4). The best score belonged to RBC-Mg concentrations with a sensitivity of 92% and an accuracy of 82% in identifying patients with DM (type 1 and type 2). The area under the ROC curves for RBC-Mg levels was 80%.    .  In the present study, we significantly detected health-related quality of life (24). In addition, a large cohort study yielded a significant association between DM (type 2 and early GDM) and poor pregnancy outcomes in women who were diagnosed with DM at <12 weeks of gestation (25).
In conclusion our data demonstrated significant alterations in albumin, Mg, and creatinine concentrations in women with DM or those at high risk of DM during their gestational age. It seems that the measurement of these biochemical parameters might be helpful for preventing the complications, and improving pregnancy outcomes complicated with DM.